tag:blogger.com,1999:blog-62970389285253775022018-03-08T10:08:33.716-05:00"Superbugs and Drugs"®"Preserving the Power of Antibiotics"®Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.comBlogger30125tag:blogger.com,1999:blog-6297038928525377502.post-41680289822366373702012-11-20T18:25:00.001-05:002012-11-20T18:25:17.500-05:00APUA Webinar on Antimicrobial Stewardship<br /><h1> Get Smart About Antibiotics Week</h1><h3> <b>November 12-18, 2012</b></h3>APUA&nbsp;is proud to have been a national partner of the CDC's <a href="http://www.cdc.gov/getsmart/campaign-materials/week/overview.html">Get Smart About Antibiotics Week</a>&nbsp;since 2010. Get Smart About Antibiotics Week is an annual effort to coordinate the work of CDC’s Get Smart: Know When Antibiotics Work campaign, state-based appropriate antibiotic use campaigns, non-profit partners, and for-profit partners during a one week observance of antibiotic resistance and the importance of appropriate antibiotic use.<br /><br />This year, for Get Smart About Antibiotics Week APUA produced a webinar about Antibiotic Stewardship.<br /><table border="0" cellpadding="1" cellspacing="1"><tbody><tr><td><h1><span style="font-size: 14px;">Containing Healthcare Associated Infections Through Antibiotic Stewardship<br />Live event: Wednesday, November 14, 2012&nbsp; 1:00 PM EST<br />PACE® credit available until May 13, 2013 </span> <br /><b><span style="font-size: 12px;">There is no charge to view this webinar.</span></b></h1></td></tr><tr><td style="text-align: center; vertical-align: top;"><a href="http://www.whitehatcom.com/Alere/Antibiotic_Stewardship_Alere_APUA_111412.pdf" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" src="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011_27_1464808900.bmp" style="float: right; height: 45px; width: 143px;" /></a> </td> <td><a href="https://whitehatevents.webex.com/ec0606l/eventcenter/enroll/register.do?siteurl=whitehatevents&amp;formId=6038232&amp;confId=6038232&amp;BU=&amp;formType=1&amp;loadFlag=1&amp;eventType=1&amp;accessType=viewRecording" style="margin-left: 1em; margin-right: 1em;"><img alt="" src="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011_26_3954154369.bmp" style="float: left; height: 45px; width: 143px;" /></a></td></tr><tr> <td><div><br /><b>Presenters:</b></div></td></tr><tr><td>Stuart Levy, M.D.<br />Professor of Medicine<br />Tufts University School of Medicine<br />President, APUA <br /><img alt="" src="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011_10_2150922682.jpg" style="float: left; height: 145px; width: 100px;" /></td> <td><br /><br />Shira Doron, M.D., M.S.<br />Assistant Professor of Medicine<br />Tufts University School of Medicine<br /><br /><img alt="" src="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011_10_1085436082.jpg" style="height: 140px; width: 100px;" /></td> </tr></tbody></table>A recent APUA study found that antibiotic-resistant infections can add nearly 13 hospital days per patient, and up to $26 billion in annual US healthcare costs*. The number of hospitalizations associated with <i>C. difficile</i> infections has tripled to 335,000 annually, while the number of deaths has quadrupled in the past decade.<br /><br />New ESBLs have evolved dramatically in the recent decades, such that few treatment options remain for infections caused by these exceptionally resistant pathogens. And of the estimated 478,000 US hospitalizations with <i>S. aureus</i> infection, approximately 58% were related to MRSA. Antimicrobial Stewardship Programs (ASPs) are recommended by the CDC and IDSA as essential in controlling these most problematic infections. This webinar will describe the nature of antimicrobial resistance, identify trends of major resistant infections, and delineate the important components of successful antimicrobial stewardship.<br /><br />This webinar will:<br />• Describe trends of major HAIs including MRSA, ESBLs and <i>C. difficile</i><br />• Review the causes and mechanisms driving antibiotic resistance problems<br />• Explain the link between antibiotic overuse and the emergence of resistant infections<br />• Review effective ASP practices and the importance of diagnostics in improving antibiotic treatment and minimizing resistance<br />• Illustrate specific examples to enhance hospital-based antimicrobial stewardship<br /><br />* (CIDOct 2009)<br /><br /><b>This webinar is produced by the Alliance for the Prudent Use of Antibiotics in conjunction with the Tufts Medical Center and is funded by an unrestricted grant from Alere.<br /> <img alt="" height="106" src="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011_10_2252356491.gif" width="105" /><img alt="" src="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011_10_3260877745.gif" style="height: 61px; width: 253px;" /></b> <br />To learn more about Antimicrobial Stewardship please see our recent APUA Clinical Newsletters:<br /><br /><a href="http://www.tufts.edu/med/apua/news/newsletter_17_4140771627.pdf" target="_blank">Volume 29 No. 3</a><br />December 16, 2011<br />"Enhancing Infection Control with Antibiotic Stewardship" <a href="http://www.tufts.edu/med/apua/news/newsletter_18_1211142861.pdf" target="_blank"><i>(PDF)</i></a><br /><br /><a href="http://www.tufts.edu/med/apua/news/newsletter_11_1945187968.pdf">Volume 29 No.1</a><br />June 14, 2011<br />"Anitbiotic Stewardship Gaining Traction: Recommended Models and Resources" <a href="http://www.tufts.edu/med/apua/news/newsletter_5_2041403174.pdf"><i>(PDF)</i></a><br /><br /><a href="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011.shtml#about%20the%20cdc%20campaign">About the CDC Campaign</a><br /><a href="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011.shtml#how%20to%20become%20a%20cdc%20get%20smart%20partner">How to Become a CDC Get Smart Partner</a><br /><a href="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011.shtml#cdc%20daily%20fact%20sheets">CDC Daily Fact Sheets</a><br /><a href="http://www.tufts.edu/med/apua/consumers/faqs.shtml">APUA Fact Sheets</a><br /><a href="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011.shtml#cdc%20brochures">CDC Brochures</a><br /><a href="http://www.tufts.edu/med/apua/news/cdc-get-smart-week-2011.shtml#cdc%20podcasts">CDC Podcasts</a>APUAhttp://www.blogger.com/profile/02741325740768864587noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-78200522582200491492011-06-03T10:05:00.006-04:002011-06-29T11:59:55.586-04:00Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry<link href="file:///C:%5CDOCUME%7E1%5Cmmix01%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5Cmmix01%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5Cmmix01%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link><style>
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</style> <br /><div class="MsoNormal"><span style="font-size: small;"><i>Dr. Lance Price is a Senior Scientist, Office of Wellness and Healthy Communities, at the Interdisciplinary Health Policy Institute as well as a Senior Science Advisor at the Pew Charitable Trusts. He is a molecular microbiologist and public health researcher. Lance is also the director of the Center for Metagenomics and Human Health at the Translational Genomics Research Institute (TGen).&nbsp;</i></span><br /><br /><span style="font-size: small;"><i> </i></span></div><div class="MsoNormal"><span style="font-size: small;">A couple weeks ago we published the first US-based, multi-state <a href="http://cid.oxfordjournals.org/content/52/10/1227.full.pdf+html">study of antibiotic resistant Staphylococcus aureus</a> in retail meat and poultry. We revealed that 47% of the samples were contaminated with <i>S. aureus </i>and that more than half of the isolates were multidrug resistant (i.e., resistant to three or more classes of antibiotics). <o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><a href="http://1.bp.blogspot.com/-B0gCmtQ6GGE/Tejqxqn_3wI/AAAAAAAAADo/mtPrzmZuAyQ/s1600/antibiotics-resistance.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="234" src="http://1.bp.blogspot.com/-B0gCmtQ6GGE/Tejqxqn_3wI/AAAAAAAAADo/mtPrzmZuAyQ/s320/antibiotics-resistance.jpg" width="320" /></a><span style="font-size: small;">I’ve done countless media interviews since the paper appeared online, and the most frequent question that I hear is “What can we do to protect ourselves?” Unfortunately, there’s no straightforward answer to this simple question. We found <i>S. aureus </i>strains with MLST sequence types identical to those of strains that colonize and infect people, but we don’t know if they’re the exact same strains. Even if they were the same strains, we don’t know if meat is a good vehicle for <i>S. aureus </i>infection—anyone who says “it is” or “it is not” is not making their statement based on robust science, because we don’t have good data on this subject yet. Industry groups and the media have largely focused on the risk from ingestion, but we should also be concerned about skin infections from handling the contaminated products. Does having a cut on your hand increase your risk? Maybe. We need to answer this. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><span style="font-size: small;">I have also read a few statements from people saying that if this were really a problem, we would have seen outbreaks of foodborne infections from contaminated products. I disagree. With such high prevalence rates, we would not expect outbreaks, but rather routine sporadic infections. <i>Campylobacter spp.</i> is a g<a href="http://www.blogger.com/post-create.do" name="_GoBack"></a>ood example of this type of observation. More than 40% of fresh chicken products in the US are contaminated with <i>Campylobacter spp.</i> and a couple million Americans are sporadically infected each year. It’s entirely possible that some of the hundreds of thousands of <i>S. aureus </i>infections that occur in the US each year are from foodborne exposure. So, with all these knowledge gaps, I answer the question, <a href="http://www.tufts.edu/med/apua/consumers/personal_home.shtml">“What can we do to protect ourselves?”</a> by saying what every good public health person would say: “wash your hands repeatedly when handling raw meat and poultry; wash your cutting boards and other equipment; separate meats from vegetables that will be eaten raw; and, definitely cook your food properly.” I also add that people should treat their meat and poultry as potential biohazards and never let children handle these products when helping out in the kitchen. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><span style="font-size: small;">Unfortunately, almost everyone has focused on the consumer end of the food chain, when the problem clearly starts with the food animal producer. The prevalence of antibiotic-resistant <i>S. aureus</i><a href="http://www.tufts.edu/med/apua/research/pew.shtml"> antibiotic use in food animal production</a>. <o:p></o:p> on meat and poultry is most likely a result of largely unregulated </span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><span style="font-size: small;">While doctors are told to use antibiotics sparingly for their patients, millions of pounds of antibiotics—many of which are important for clinical medicine—are used as common production tools to improve feed efficiency, stimulate growth, and prevent diseases in food animals. I was once told “antibiotics is a crutch for poor animal husbandry” by the owner of a major US poultry production company. I am not a veterinarian, but I can say with confidence that any animal production system that requires the routine input of antibiotics to keep animals from becoming sick <i>is a broken system</i>. There is no justification for this flagrant antibiotic abuse while doctors and scientists are working frantically to preserve the utility of these drugs to treat sick people.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><span style="font-size: small;">So what’s next? Now that we know that multidrug resistant <i>S. aureus </i>is common in our food supply, we need to define the risk to consumers. Occupational studies are probably the most powerful place to start. Studying food animal workers will tell us about the infectious potential of the strains that we’re finding on our food. Looking at prep cooks and butchers will move us even closer to the risk posed by handling meat and poultry. But, we’ll eventually have to bring these studies to the consumer’s kitchen to see how and how often consumers are exposed to <i>S. aureus </i>from food. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><span style="font-size: small;">All that said, our future research shouldn’t follow the lead of the media and focus exclusively on the consumer end of the food chain. We also need to better understand the situation in the CAFO and slaughterhouse. How can we decrease antibiotic-resistant <i>S. aureus </i>colonization among food animals in CAFOs? How can we reduce meat contamination in the slaughter facilities? And one urgent question in my mind is: What is the relationship between ceftiofur use and MRSA colonization among food animals? Ceftiofur is a third generation cephalosporin and has been shown to kill off other <i>S. aureus </i>and select directly for MRSA in the laboratory. Are the new MRSA strains—such as ST398—that we are seeing in food animals a direct result of ceftiofur use? We need to answer all of these questions, but we’ll need cooperation by the food animal industry to do so.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><span style="font-size: small;">Anyway, there are lots of import questions to answer here, and I’d be interested in hearing your thoughts…<o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: small;"><br /></span></div><div class="MsoNormal"><span style="font-size: small;">Lance</span><o:p></o:p></div>APUAhttp://www.blogger.com/profile/11084383928444078635noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-1921388178809036062011-05-12T09:48:00.000-04:002011-05-13T16:37:22.304-04:00Evidence-Based Strategies for the Containment of Antibiotic Resistance<div class="MsoNormalCxSpFirst"><img src="http://www.tufts.edu/med/apua/intl_chapters/south_africa_5_1399477238.bmp" /></div><div class="MsoNormalCxSpFirst"></div><div class="Default"><span style="font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt;"><i><a href="http://www.tufts.edu/med/apua/intl_chapters/south_africa.shtml">Professor Sabiha Essack</a> (B. Pharm., M. Pharm., PhD), Dean of the Faculty of Health Sciences and Professor in the School of Pharmacy and Pharmacology at the University of KwaZulu-Natal is a Welcome Trust Research Fellow who completed research towards her PhD in Pharmaceutical Microbiology at St Bartholomew’s and the Royal London School of Medicine and Dentistry in the United Kingdom. She is also the president of APUA-South Africa.</i></span></div><div class="Default"><br /></div><div class="MsoNormalCxSpFirst"><span lang="EN-GB" style="font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt;"><a href="http://www.tufts.edu/med/apua/about_issue/antibiotic_res.shtml">Antimicrobial resistance</a> is currently the greatest challenge to the effective treatment of infections globally. </span><span lang="EN-GB" style="font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt;">Resistance adversely affects both clinical and financial therapeutic outcomes with effects ranging from the failure of an individual patient to respond to therapy and the need for expensive and/or toxic alternative drugs to the social costs of higher morbidity and mortality rates, longer durations of hospitalisation, increased <a href="http://www.tufts.edu/med/apua/research/completed_projects_4_3378722343.pdf">health care costs</a> and the need for changes in empirical therapy. Resistance may emerge by selection pressure (overuse/indiscriminate antimicrobial use in developed vs under-use/misuse in developing countries) but is perpetuated by diverse risk factors and maintained within environments as a result of poor infection control. Population-specific drug pharmacokinetics and pharmacodynamics also play a role. The <a href="http://www.who.int/en/">WHO</a>, US, UK and EU have initiated strategies for the containment of resistance, with surveillance critical to all. <o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span lang="EN-GB" style="font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt;"><o:p>S</o:p></span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;">urveillance in </span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;"><a href="http://www.tufts.edu/med/apua/intl_chapters/south_africa.shtml">South Africa</a></span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;"> should be disease-based, establishing sensitivity profiles of common causative organisms to inform the development of or amendment to standard treatment guidelines and essential drugs lists adopted within national drug policies in developing countries globally.</span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;"> </span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;">The manner of antimicrobial use (overuse, underuse, inadequate dosing) associated with resistance must be established for appropriate intervention in terms of </span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;"><span style="letter-spacing: -0.15pt;">rational drug use, a reduction in use and dosing regimens based on population-specific pharmacokinetics and pharmacodynamics</span></span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;">.</span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;"> </span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;">Risk factors unique to South African communities (poverty, HIV) and hospitals (duration of hospitalisation, location within the hospital, intensive care unit stay, surgery, wounds, previous and current antimicrobial therapy, mechanical ventilation, urinary catherterisation, nasogastric intubation, central venous and peripheral catheters, previous hospitalisation and transfer from another unit or hospital) must be determined and </span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;"><span style="letter-spacing: -0.15pt;">due vigilance exercised in patients exhibiting classical risk factors for the acquisition of or colonisation with resistant pathogens.</span></span><span class="Apple-style-span" style="font-family: Calibri,sans-serif; font-size: 15px;"> </span></div><div class="MsoNormalCxSpMiddle"><span lang="EN-GB" style="font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; letter-spacing: -0.15pt;"> &nbsp;</span></div><div class="MsoNormalCxSpMiddle"><span lang="EN-GB" style="font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; letter-spacing: -0.15pt;">Hygiene and sanitation (in communities) and <a href="http://www.tufts.edu/med/apua/practitioners/infection_control.shtml">infection control</a> (in hospitals) status must be determined and interventions initiated to prevent the spread of resistance. Pharmacokinetics and pharmacodynamics specific to diverse populations must be devised to optimise antimicrobial therapy. </span><span lang="EN-GB" style="font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt;">Evidence-based treatment of infections guided by local susceptibility/resistance would ensure productive, economically viable individuals capable of fulfilling their social roles. Efficacious treatment would assure sustainable livelihoods in all populations (healthy and otherwise) as infections are the most frequently encountered health problem even in the absence of HIV/AIDS. While one infection will ultimately be fatal, the efficacious use of antibiotics will successfully treat several infections in the lifetime of the AIDS patient even in the presence of a compromised immune system sustaining the economic viability of the country and preventing the economic collapse portended by the World Bank. <span style="letter-spacing: -0.15pt;">South Africa has unique needs in the antimicrobial resistance arena, needs to be addressed in the context of severe financial, human resources and technological challenges. <o:p></o:p></span></span></div>Devi Bajajhttp://www.blogger.com/profile/02098972645788149841noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-4638906524644624542011-04-28T11:02:00.007-04:002011-04-28T11:17:40.167-04:00Infection Prevention + Optimal Antibiotic Use = Zero Infections<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span><span class="Apple-style-span"><i><span class="Apple-style-span" >Julia Moody, MS SM (ASCP), Clinical Director, Infection Prevention, Clinical Services Group, <span class="Apple-style-span" style="font-style: normal; ">HCA, Inc</span>, APIC Antimicrobial Stewardship Task Force</span><b><a name="_GoBack"></a><o:p></o:p></b></i></span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span><span class="Apple-style-span"><i><span class="Apple-style-span"><br /></span></i></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-indent: .25in;line-height:normal"><span><o:p><span class="Apple-style-span"><b><i> </i></b></span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-indent: .25in;line-height:normal"><span class="Apple-style-span"><span>Antibiotics are the second most common medication prescribed in the US. Although the discovery of antibiotics advanced the treatment of infections, excessive use frequently occurs. Bacteria easily adapt to become resistant, often at an alarming rate, posing a threat to public health safety, because new, more powerful antibiotic development is limited. This threat to public health safety was recognized on </span><a href="http://www.who.int/world-health-day/2011/en/index.html"><span>World Health Day</span></a><span>, April 7, 2011, and endorsed by </span><a href="http://www.cdc.gov/"><span>Centers for Disease Control and Prevention</span></a><span> (CDC) and healthcare professional organizations in the U.S. To address the threat, antimicrobial stewardship programs are instituted to optimize antibiotic use and improve patient outcomes, while decreasing the development of resistance. <o:p></o:p></span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-indent: .25in;line-height:normal"><span class="Apple-style-span" style="font-family: arial; font-size: small; ">Antibiotic exposure is the single most important risk factor in <i>C. difficile</i> infection,<i> </i>a cause of severe diarrhea, serious intestinal complications and death. In some parts of the U.S., <i>C. difficile</i> is more common than MRSA. New cases of <i>C. difficile</i> infection occurring during a hospital stay are an indicator of adverse drug events as there is growing evidence that the risk for infection drops with antimicrobial stewardship.</span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-indent: .25in;line-height:normal"><span class="Apple-style-span" style="font-family: arial; font-size: small; ">What is the science of infection prevention and the value for hospitalized patients? Hospitals are where the most vulnerable patients in intensive care units, those with chronic health conditions and whose immune systems are unable to fight infection, rely totally on antibiotics to treat life-threatening infections. Resistant bacteria can leave these patients without an effective antibiotic for their infections.</span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-indent: .25in;line-height:normal"><span class="Apple-style-span" style="font-family: arial; font-size: small; "><span>How does the role of </span><a href="http://www.apic.org/AM/Template.cfm?Section=About_the_Profession&amp;Template=/CM/HTMLDisplay.cfm&amp;ContentID=17482"><span>infection preventionists</span></a><span> decrease the risk of infections and slow the pace of antibiotic resistance in healthcare settings? Infection prevention uses scientifically proven concepts to (1) identify trends and occurrences of drug resistant bacteria [MDROs], like MRSA, and new, emerging resistance in gram negative bacteria; (2) apply practices to prevent transmission of these MDROs to other patients, using bundles of hand hygiene before and after patient contact, isolation precautions placing patients in private rooms, where caregivers wear gowns and gloves, and environmental cleaning to ensure that surfaces and equipment are completely cleaned to reduce the presence of bacteria in the environment; (3) implement care bundles – like checklists – that when consistently performed, reduce the risk of getting an infection from use of catheters or after undergoing a surgical procedure; and (4) share findings of MDRO-related infections with the antimicrobial stewardship team members to identify successes and improvement opportunities.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-indent: .25in;line-height:normal"><span class="Apple-style-span" style="font-family: arial; font-size: small; "><span>What have been the outcomes? In the past 10 years, healthcare epidemiologists and infection preventionists – in collaboration with their direct care co-workers – have documented dramatic reductions in the frequency of infections, especially among patients in ICUs, as reported into the CDC’s </span><a href="http://www.cdc.gov/nhsn/"><span>National Healthcare Safety Network</span></a><span> (NHSN) database.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-indent: .25in;line-height:normal"><span class="Apple-style-span" style="font-family: arial; font-size: small; ">What can you do today to prevent infections and save antibiotics for their intended use? Practice good hand hygiene with alcohol based hand rubs or soap and water, know what common infections do not respond to antibiotics, like the common cold, viral sore throats and influenza, take the full dose of antibiotics when prescribed for true infections, and keep current on vaccinations.</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;mso-ascii-font-family:Calibri;mso-ascii-theme-font: minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin"><o:p><span class="Apple-style-span"> </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;mso-ascii-font-family:Calibri;mso-ascii-theme-font: minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin"><o:p><span class="Apple-style-span"> </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;mso-ascii-font-family:Calibri;mso-ascii-theme-font: minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin"><o:p> </o:p></span></p>Devi Bajajhttp://www.blogger.com/profile/02098972645788149841noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-86411693634010644372011-04-07T13:51:00.000-04:002011-04-07T13:51:29.860-04:00Why Urgent Action is Needed to Safeguard Drug Treatments for Future Generations<div class="separator" style="clear: both; font-family: 'Segoe UI',Helvetica,Arial,sans-serif; font-size: medium; margin-bottom: 14pt; margin-top: 14pt; text-align: center;"><a href="http://4.bp.blogspot.com/-OBcHN7501FE/TZ33NIcvjwI/AAAAAAAAADg/6gaNEuKlh_4/s1600/HIGH-WHD-HOR-EN_Page_2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="228" r6="true" src="http://4.bp.blogspot.com/-OBcHN7501FE/TZ33NIcvjwI/AAAAAAAAADg/6gaNEuKlh_4/s320/HIGH-WHD-HOR-EN_Page_2.jpg" width="320" /></a></div><div style="font-family: 'Segoe UI',Helvetica,Arial,sans-serif; font-size: medium; margin-bottom: 14pt; margin-top: 14pt;"><i><span lang="en-US" style="font-family: Arial,Helvetica,sans-serif; font-size: small;">Dr Mario Raviglione is Director of the WHO Stop TB Department. He is leading preparations for World Health Day 2011. </span><span lang="en-US"></span></i></div><div style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;">The <a href="http://www.who.int/en/">World Health Organization (WHO)</a> is marking <a href="http://www.who.int/world-health-day/2011/en/index.html">World Health Day – April 7</a> - this year with a call to Combat Drug Resistance and protect vital antimicrobial drugs the effectiveness of which is increasingly under threat. We believe that concerted action under the stewardship of governments, and engaging health professionals such as prescribers and pharmacists. Civil society and the pharmaceutical industry is needed to slow down the impact of drug resistance and preserve medical advances for future generations. </span><span lang="en-US" style="font-size: small;"></span></div><div style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;">Every year, WHO uses the anniversary of its founding to draw the world’s attention to an urgent health problem. Clearly, drug resistance fits the definition. It’s not a new problem, but it still needs urgent action across the health sector and beyond it.</span></div><div style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;">In h<a href="http://www.who.int/mediacentre/news/statements/2011/whd_20110407/en/index.html">er message</a> to governments around the world, the <a href="http://www.who.int/dg/en/">WHO Director-General, Dr Margaret Chan</a>, spelled out the problem: "The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures." In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated. </span><span lang="en-US" style="font-size: small;"></span></div><div style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;">On Thursday, WHO will publish a policy package that spells out the measures governments and their national partners need to take to safeguard these vital medicines.</span></div><div style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;"></span><span lang="en-US" style="font-size: small;">We know that the discovery and use of antimicrobial drugs to treat diseases such as leprosy, tuberculosis, malaria, gonorrhea, syphilis, pneumonias and other killer diseases has changed the course of our history as a species. We must act now to prevent those discoveries from being put at risk. </span><span lang="en-US" style="font-size: small;"></span></div><div style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;">Tuberculosis, malaria and HIV all face severe constraints due to rising levels of resistance, and resistant strains of gonorrhea and shigella are limiting treatment options. Serious infections acquired in hospitals are now often fatal because they are so difficult to treat and drug-resistant strains of microorganism are spread overnight from one geographical location to another in today's interconnected and globalized world. Resistance is also emerging to the antiretroviral medicines used to treat people living with HIV. </span><span lang="en-US" style="font-size: small;"></span></div><div align="justify" style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;">Over the last decade, WHO has established many initiatives to understand and address drug resistance - particularly in relation to some of the world's most deadly infectious diseases. Those measures must now be further strengthened and implemented. New collaborations, led by governments working alongside civil society, health professionals and the private sector are essential if we are to halt the public health threat of drug resistance.</span></div><div style="font-family: Arial,Helvetica,sans-serif; margin-bottom: 14pt; margin-top: 14pt;"><span lang="en-US" style="font-size: small;"></span><span lang="en-US" style="font-size: small;"><a href="http://www.tufts.edu/med/apua/">APUA</a> has been a leader in promoting rational use of drugs and prevention and containment of antimicrobial resistance for many years. WHO looks forward to an intensified collaboration with APUA and all its chapters.</span><br /><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></div>APUAhttp://www.blogger.com/profile/11084383928444078635noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-90442715256232553432011-03-18T14:07:00.002-04:002011-03-18T15:26:20.306-04:00The Overuse of Antibiotics in Food Animal Production Needs to Be Addressed<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0in;"><span class="Apple-style-span" style="font-size: small;">The <a href="http://www.fda.gov/">Food and Drug Administration</a> (FDA) issued <a href="http://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/GuidanceforIndustry/UCM216936.pdf">guidelines</a> to curb the non-therapeutic use of antibiotics in food-producing animals last June. The hope is that food producers will reserve these vital antibiotics for disease treatment and prevention.&nbsp; According to the FDA, in 2009 nearly 29 million pounds of antibacterial drugs (includes 3.7 million kilograms of Ionophores) were sold for animal use, almost four times the amount sold for human use that year. Data released later last year revealed that of all the antibiotics used in the United States, <a href="http://www.foodsafetynews.com/2011/02/fda-confirms-80-percent-of-antibiotics-used-in-animal-ag/">80% is used in animals and the use is not to treat or prevent disease</a>, but to make the animals gain weight faster and to compensate for the crowded conditions often found in such enormous facilities.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0in;"><span style="font-size: small;"><br /></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0in;"><span class="Apple-style-span" style="font-size: small;">APUA believes that more action needs to be taken on this issue and that these guidelines will have little impact in fighting the growing threat of antibiotic resistance to public health unless the agency halts the practice and establishes a <a href="http://www.tufts.edu/med/apua/news/press_release_8-31-10.shtml">system to monitor compliance</a>.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0in;"><span style="font-size: small;"><br /></span></div><div style="font-family: Arial,Helvetica,sans-serif; margin: 0in;"><span style="font-size: small;"><span class="Apple-style-span">High-volume use of antibiotics at food animal production sites is a major contributor to the selection and transfer of <a href="http://www.tufts.edu/med/apua/news/press_release_8-31-10.shtml">resistance</a> genes that can end up in human pathogens. <o:p></o:p></span></span></div><div style="font-family: Arial,Helvetica,sans-serif; margin: 0in;"><span style="font-size: small;"><br /></span></div><div style="font-family: Arial,Helvetica,sans-serif; margin: 0in;"><span style="font-size: small;"><span class="Apple-style-span">What are your thoughts on the use of antibiotics in food animal production? <o:p></o:p></span></span></div><div style="font-family: Arial,Helvetica,sans-serif; margin: 0in;"><span style="font-size: small;"><br /></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0in;"><span class="Apple-style-span" style="font-size: small;">For more information please contact Carol Cogliani</span></div>APUAhttp://www.blogger.com/profile/11084383928444078635noreply@blogger.com1tag:blogger.com,1999:blog-6297038928525377502.post-83328591790762233812011-02-25T14:53:00.001-05:002011-02-25T15:01:47.098-05:00Resistant Salmonella Concord from Ethiopia<link href="file:///C:%5CDOCUME%7E1%5Cmmix01%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5Cmmix01%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CDOCUME%7E1%5Cmmix01%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link><style>
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</style> <br /><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><i>APUA chapter advisor for sub-Saharan Africa, Dr. Iruka Okeke, Ph.D. and current assistant professor of biology at Haverford College offers her insights on drug-resistant Salmonella Concord infections in Ethiopian adoptees.</i></span><br /><span style="font-size: small;"><br /></span><br /><span style="font-size: small;">There have been a number of worrisome reports in the recent medical literature about drug-resistant <i>Salmonella</i> Concord infections in Ethiopian adoptees.&nbsp; The reports come from the <a href="http://journals.lww.com/pidj/Abstract/2009/09000/Emergence_of_Multidrug_Resistant_Salmonella.12.aspx">USA, France, Norway</a> and <a href="http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19587">Denmark</a>, plus a case report from <a href="http://jac.oxfordjournals.org/content/65/7/1545.short">Spain</a>.&nbsp; Based on global epidemiology of <i>Salmonella</i>, which includes very little information from every country in Africa combined, <i>Salm.</i> Concord is unusual.&nbsp; The reports about what seems to be an epidemic come from less than two hundred individuals in all over a period of about seven years.&nbsp; Thus, in a sense, they represent an archetypical example of what University of Virginia’s Richard Guerrant and his co-workers referred to as the ‘<a href="http://cid.oxfordjournals.org/content/41/Supplement_8/S524.long">eyes of the hippopotamus</a>’ &nbsp;– a mere scratch on the surface of what could be a deeper problem of unimaginable girth.&nbsp; </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><o:p>&nbsp;</o:p>Unfortunately, too much of what we know about pathogens and drug resistance in resource-limited areas still comes from studies performed very distant from those places - &nbsp;on isolates from returning travelers, or as in the <i>Salmonella</i> Concord case, recent immigrants.&nbsp; Is it true, as some have suggested, that selection of resistant <i>Salmonella</i> Concord occurs in orphanages that overuse or abuse antibiotics in order to speed up adoption and empty out needed spaces?&nbsp; Could we nip the problem in the bud by restricting antibiotic use in a few institutions and prescreening international adoptees?&nbsp; Or is the average Ethiopian child at equal risk of a <i>Salmonella</i> Concord infection, with a significantly lower chance of having it detected and treated appropriately?&nbsp; And are other, less susceptible individuals transporting <i>Salmonella</i> genomes packed with mobile resistance genes from endemic areas with an efficiency that is analogous to human transport via concord only a decade before?&nbsp; Should we be developing a <i>Salm</i>. Concord vaccine to deal with the last two possibilities?&nbsp; Or will the current apparent outbreak burn itself out before we get started?</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><o:p>&nbsp;</o:p>Getenet Beyene and co-workers have finally performed a small, but much-needed study to address these vital questions and they’ve done so where it is needed – in Addis Ababa and rural South-West Ethiopia.&nbsp; The results, published in the <a href="http://www.jidc.org/index.php/journal/issue/view/58">January 2011 issue of the <i>Journal of Infections in Developing Countries</i></a>, are clarifying, if troubling. &nbsp;Working at Tikur Anbessa Hospital in Addis Ababa and Jimma University Hospital, the researchers looked for <i>Salmonella</i> and other pathogens in the blood of patients with fever and in stool specimens from individuals with diarrhea.&nbsp; Non-typhoidal Salmonella were isolated from the blood of 26 patients and from the stool of 59 more individuals.&nbsp; <i>Salmonella enterica</i> serovariety Concord was the most common Salmonella serovar detected, being four times as common as all other Salmonella combined, and it was more invasive than other serovarieties.&nbsp; &nbsp;The lack of evidence of clonality among the isolates suggests that this is no new epidemic and data from a smaller study published 25 years ago report <i>Salm</i>. Concord from Ethiopia, strongly suggesting that this pathogen has lurked undetected for at least a quarter of a century (Ashenafi and Gedebou, 1985, Trans R Soc Trop Med Hyg 79: 719-721).&nbsp; Since 1985, <i>Salm</i>. Concord isolates from Ethiopia appear to have become more prevalent, and resistant to more antibiotics.&nbsp; The isolates in the recent report were resistant to most affordable antibacterial options in Ethiopia.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><o:p>&nbsp;</o:p>Oddly, the literature suggests that this serovar has a narrow geographic range.&nbsp; However, our perceptions can only be as broad as our vision. There are reasonably good data from Kenya, which suggest that <i>Salm</i>. Typhimurium and Typhi are more important there, but with next to no data from other nearby locations, we cannot be sure that the problem is not extensive. While the endemicity, invasiveness and resistance of <i>Salm</i>. Concord in Ethiopia all give cause for concern, as Beyene et al emphasize in their discussion, the now global problem of multidrug-resistant Salmonella Concord must be addressed from endemic areas.&nbsp; The very first step is determining where these are, and what exactly are the risk factors for infection.&nbsp; Everyone is at risk when any part of the world lacks the diagnostic capacity to identify, track and control resistant pathogens. Microbes made the resistance problem a global one decades ago.&nbsp; To deter them, we need local surveillance worldwide.&nbsp; </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><o:p>&nbsp;</o:p>Iruka N Okeke</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Haverford College</span></div><div class="MsoNormal"><br /></div>APUAhttp://www.blogger.com/profile/11084383928444078635noreply@blogger.com5tag:blogger.com,1999:blog-6297038928525377502.post-86066092368115131792011-02-14T12:39:00.015-05:002011-02-25T15:58:07.835-05:00The International Society of Chemotherapy's African Network<a href="http://4.bp.blogspot.com/-HljSq_1O7fA/TVlwSRFnIpI/AAAAAAAAADY/S72xI5gjF5Y/s1600/ian%2Bgould%2Bfinal.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5573609472974594706" src="http://4.bp.blogspot.com/-HljSq_1O7fA/TVlwSRFnIpI/AAAAAAAAADY/S72xI5gjF5Y/s200/ian%2Bgould%2Bfinal.jpg" style="cursor: pointer; float: left; height: 200px; margin: 0pt 10px 10px 0pt; width: 200px;" /></a><br /><div><span class="Apple-style-span"><div id="previewbody" style="display: block; margin-left: 0.2em;"><div style="background-color: transparent; margin: 0px;"><i><span class="Apple-style-span"><span class="Apple-style-span" style="white-space: pre-wrap;"></span><span class="Apple-style-span"><span class="Apple-style-span" style="color: #666666;"><span id="internal-source-marker_0.0374317008536309" style="background-color: transparent; color: black; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">APUA expert panel member and Secretary General of the International Society of Chemotherapy, Dr. Ian Gould, discusses launching of the ISC African Network.</span></span></span></span></i></div><div style="background-color: transparent; margin: 0px;"><span class="Apple-style-span"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #666666; font-family: Times;"><span id="internal-source-marker_0.0374317008536309" style="background-color: transparent; color: black; font-family: 'Times New Roman'; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></span></span></span></div><div style="background-color: transparent; margin: 0px;"><span class="Apple-style-span"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #666666;"><span id="internal-source-marker_0.0374317008536309" style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recently </span></span></span><span class="Apple-style-span"><span class="Apple-style-span" style="color: #666666;"><span id="internal-source-marker_0.0374317008536309" style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">in South Africa, as </span></span><span class="Apple-style-span"><a href="http://www.ischemo.org/"><span style="background-color: transparent; font-style: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Secretary General of the International Society of Chemotherapy</span></a></span><span class="Apple-style-span"><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span">,</span> I was very please</span></span></span><span class="Apple-style-span"><span class="Apple-style-span"><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">d to be able to launch a new initiative- the ISC African network. The </span></span></span><span class="Apple-style-span"><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">network will work in close conjunction with the ISC working group on Antibiotic Stewardship (AS) which is co-chaired by <span class="Apple-style-span"><a href="http://www.ischemo.org/02_WG_MRSA_AntimicrobialStewardship.html"><span class="Apple-style-span">Gabriel Levy Hara (Argentina)</span></a> </span>and Jim Hutchison (Canada). </span></span><span class="Apple-style-span"><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">It will be a working group of the Infection Prevention Control African Network (IPCAN) jointly with <a href="http://www.ischemo.org/"><span class="Apple-style-span">ISC</span></a>.</span></span><span class="Apple-style-span"><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></span></span></div><div style="background-color: transparent; margin: 0px;"><span class="Apple-style-span"><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></span></div><div style="background-color: transparent; margin: 0px;"><span class="Apple-style-span"><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The aims are to create a worldwide web-based compilation of <span class="Apple-style-span"><a href="http://inventory.infectionnet.org/">antimicrobial stewardship</a></span> efforts and activities, the people involved with them, their products and accomplishments. The </span><a href="http://inventory.infectionnet.net/"><span style="background-color: transparent; font-style: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">website</span></a><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> will display the collected information and promote sharing. It will be used as a platform for further Antimicrobial Stewardship Working Group initiatives. We believe that this could really help colleagues of different specialities (physicians, pharmacists, microbiologists and health care managers) in formulating and enacting AS initiatives.</span><br /><span class="Apple-style-span" style="background-color: transparent; color: #666666;"><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Other aims of the ISC AS working group include: </span></span><br /><ol style="color: #666666;"><li style="background-color: transparent; color: black; font-style: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Performing international studies of antimicrobial consumption in all five continents.</span></li><li style="background-color: transparent; color: black; font-style: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Distance learning courses to address specific and locally prevalent problems (e.g., rational management of URI, principles and experiences with antimicrobial stewardship programs, frequent problems regarding antimicrobial use in the elderly, etc).</span></li><li style="background-color: transparent; color: black; font-style: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">To work with pharmacists of the different countries in common aspects (regulation, educational programs) regarding use and misuse of antimicrobials.</span></li><li style="background-color: transparent; color: black; font-style: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">To advocate for the regulation of sales and distribution of antimicrobials worldwide.</span></li><li style="background-color: transparent; color: black; font-style: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">To hold meetings to highlight stewardship issues.</span></li></ol><span class="Apple-style-span"><span style="background-color: transparent; color: black; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">We are also in discussion about a first position statement to include critical tips in prescribing. ISC is in regular contact with other groups active in this area such as</span><span style="background-color: transparent; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"> <a href="http://www.who.int/en/"><span class="Apple-style-span">WHO</span></a></span>, <a href="http://www.tufts.edu/med/apua/"><span class="Apple-style-span">APUA</span></a>, <a href="http://www.cddep.org/">CDDEP</a><a href="http://www.rff.org/Pages/default.aspx"><span class="Apple-style-span"></span></a> and <a href="http://www.cgdev.org/"><span class="Apple-style-span">CGD</span></a> as we need to join forces as much as is possible in this critical area.</span><br /><span class="Apple-style-span" style="background-color: transparent; color: #666666;"><span style="background-color: transparent; color: black; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span class="Apple-style-span" style="background-color: transparent; color: #666666;"><span style="background-color: transparent; color: black; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span style="background-color: transparent; color: black; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I M Gould </span></span></div></div></span></div>APUAhttp://www.blogger.com/profile/11084383928444078635noreply@blogger.com1tag:blogger.com,1999:blog-6297038928525377502.post-5111860589444366212011-01-18T11:46:00.006-05:002011-01-18T12:01:52.570-05:00The APUA African Chapter Network Initiative Uncovers New Data to Guide Improved Antibiotic Therapy<span style="font-size:100%;">In 2001, APUA set out to develop a chapter network in Sub-Saharan Africa to supplement the limited resources available there to fight high rates of infectious disease. A major focus has been reduction of preventable or easily treatable bacterial diseases such as pneumonia and diarrheal diseases which are prevalent in the general population and often co-infect HIV patients.<br /><span style=""><br /></span></span><p class="MsoNormal"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_EfP1Ngocgks/TTXFAQAjfrI/AAAAAAAAAB8/pxMpteyzlQA/s1600/AR-SANA%2BZambia%2Btraining%2Bfor%2Binterns%2Bfor%2Bfield%2Bwork.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 271px;" src="http://4.bp.blogspot.com/_EfP1Ngocgks/TTXFAQAjfrI/AAAAAAAAAB8/pxMpteyzlQA/s320/AR-SANA%2BZambia%2Btraining%2Bfor%2Binterns%2Bfor%2Bfield%2Bwork.jpg" alt="" id="BLOGGER_PHOTO_ID_5563569522774081202" border="0" /></a></p> <p class="MsoNormal"><span style="font-size:100%;">Since 2001, APUA has established chapters in Ethiopia, Gambia, Kenya, Mozambique, Namibia, Nigeria, Senegal, South Africa, Tanzania, Uganda, and Zambia, with several more under development. APUA chapters in <a href="http://www.tufts.edu/med/apua/intl_chapters/zambia.shtml">Zambia</a> and <a href="http://www.tufts.edu/med/apua/intl_chapters/uganda.shtml">Uganda</a> facilitated introduction of APUA’s recent situation analysis funded by the <a href="http://www.gatesfoundation.org/Pages/home.aspx">Bill and Melinda Gates Foundation</a>. With the chapters’ assistance, APUA staff, Dr. Susan Foster and Dr. Aníbal Sosa coordinated in-country research teams of over 100 workers, compiling over 10,000 records from rural and urban sites. At the end of the two year study, country stakeholders were convened to consider implications and recommend interventions.</span><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_EfP1Ngocgks/TTXFl1zVzUI/AAAAAAAAACE/W8HVn2GpqKo/s1600/Medical%2Bstudents%2Bin%2BUganda%2Blearn%2Bto%2Buse%2Bthe%2Bdata%2Bentry%2Bprogram.jpg"><img style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 266px;" src="http://4.bp.blogspot.com/_EfP1Ngocgks/TTXFl1zVzUI/AAAAAAAAACE/W8HVn2GpqKo/s320/Medical%2Bstudents%2Bin%2BUganda%2Blearn%2Bto%2Buse%2Bthe%2Bdata%2Bentry%2Bprogram.jpg" alt="" id="BLOGGER_PHOTO_ID_5563570168574364994" border="0" /></a></p> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:100%;">Key findings from the APUA situation analysis in Zambia and Uganda include:</span></p> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style=""><span style="font-size:100%;">Health staff are still commonly prescribing the antibiotic cotrimoxazole for acute respiratory infection due to S. pneumoniae — even though resistance levels to this drug are very high and the standard for treatment has been changed to amoxicillin. </span></li><li class="MsoNormal" style=""><span style="font-size:100%;">Febrile children even with respiratory distress are almost as likely to get a drug meant to treat malaria as they are to get an antibiotic.</span></li><li class="MsoNormal" style=""><span style="font-size:100%;">In both countries, laboratories need to be upgraded with the proper equipment to collect data on drug resistance rates to various antibiotics and treatment guidelines need to be updated more frequently.</span></li></ol> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:100%;">The APUA global chapter network in over 65 countries seeks to improve diagnosis and treatment of infections through improving regulatory policies and clinical practices. The APUA works in close collaboration with other organizations including the <a href="http://www.who.int/en/">WHO</a>, <a href="http://www.cgdev.org/">CGD</a>, and the <a href="http://www.cdc.gov/">CDC</a>. For more information on the APUA Global Chapter Network see the <a href="http://www.tufts.edu/med/apua/intl_chapters/network.shtml">APUA Chapter Network</a> page on our Web site or to learn more about the <a href="http://www.tufts.edu/med/apua/research/gates.shtml">Gates Foundation Project</a> in Zambia and Uganda visit our <a href="http://www.tufts.edu/med/apua/research/israr.shtml">Current Projects</a> page.</span></p> <p class="MsoNormal" style="margin-left: 0.25in;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:100%;"><br /></span></p> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:100%;"><o:p> </o:p></span></p>APUAhttp://www.blogger.com/profile/11084383928444078635noreply@blogger.com1tag:blogger.com,1999:blog-6297038928525377502.post-86765603243813553442010-12-20T10:50:00.009-05:002010-12-20T11:10:02.626-05:00Beating resistance? Yes it can be done!<em><a href="http://superbugsanddrugs.blogspot.com/p/expert-panel-members.html">Dr. Steven J. Projan </a>is the Senior Vice President of Research and Development and Innovative Medicines Head of Infectious Diseases and Vaccines at MedImmune.</em><br /><br /><a href="http://2.bp.blogspot.com/_RnUenXGH7og/TQ99V2MBqcI/AAAAAAAAAGo/mDDNm0QjQAE/s1600/39576.JPG"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 145px; FLOAT: left; HEIGHT: 200px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5552794679847791042" border="0" alt="" src="http://2.bp.blogspot.com/_RnUenXGH7og/TQ99V2MBqcI/AAAAAAAAAGo/mDDNm0QjQAE/s200/39576.JPG" /></a>The question posed is: In an ideal world, what would be your approach to accelerating drug development and strengthening antibiotic stewardship? First and foremost we need to do a better job of encouraging basic research in microbiology because it is from a profound understanding of the underlying biology that all drug discovery comes. The good news is that funding in this area has improved (although given the recent political events this may be a transitory phenomenon) and technology marches on allowing new insights on the microbial ecology of the human being. And when those novel discoveries are made we need a far more sophisticated approach to both drug development and regulatory processes such as basing decisions on “Real World Evidence” rather than the artificiality of Phase III clinical trials. But in terms of stewardship it is becoming increasingly clear that the best way to deal with infections due to resistant bacteria is to prevent them in the first place. As such an increased emphasis on prophylaxis is the best approach from a public health point of view. The success of the pneumococcal conjugate vaccine in reducing the use of antibiotics has been well documented; however another important way to curtail the use of antibacterial drugs is to prevent viral respiratory infections, especially lower respiratory infections (it should be noted that 1/3rd to 2/3rd of the mortality in H1N1 influenza patients was due to secondary bacterial pneumonias and other respiratory viruses such RSV or human rhinovirus type C are likely to play role here as well). Therefore vaccines and immunoprophylactics for both viral and bacterial infections should play an increasing role in both public health practices and industrial research. To further focus our industrial efforts (and stimulate additional research) I support the Infectious Disease Society of America’s call for longer periods of market exclusivity for novel infectious disease products.APUAhttp://www.blogger.com/profile/08697038324333876545noreply@blogger.com2tag:blogger.com,1999:blog-6297038928525377502.post-34685893908375676432010-12-14T18:44:00.007-05:002010-12-15T09:30:07.708-05:00Discovery & Stewardship of Narrow Spectrum Antibiotics<span style="font-style: italic;font-family:&quot;;font-size:100%;color:black;" ><span style="font-family:arial;">APUA board member, <a href="http://superbugsanddrugs.blogspot.com/p/expert-panel-members.html">Philip Walson, M.D</a>., who is the Editor-in-Chief of Clinical Therapeutics, provided his comments on the recent article, </span></span><span style="font-style: italic;font-family:&quot;;font-size:100%;color:black;" ><span style="font-family:arial;">"<a href="http://www.xconomy.com/san-diego/2010/11/30/optimer-seeks-quick-green-light-from-fda-for-antibiotic-against-deadly-bug/">Optimer Seeks Quick Green Light From FDA for Antibiotic Against Deadly Bug</a>"</span></span><p class="MsoNormal"><span style=";font-family:&quot;;font-size:100%;color:black;" ><span style="font-family:arial;">It is too early t</span></span><span style="font-size:100%;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_RnUenXGH7og/TQgC6PUUxHI/AAAAAAAAAGY/Pj9cpWvi5o0/s1600/Phil%2BWalson.JPG"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 107px; height: 126px;" src="http://3.bp.blogspot.com/_RnUenXGH7og/TQgC6PUUxHI/AAAAAAAAAGY/Pj9cpWvi5o0/s200/Phil%2BWalson.JPG" alt="" id="BLOGGER_PHOTO_ID_5550689740301583474" border="0" /></a></span><span style=";font-family:&quot;;font-size:100%;color:black;" ><span style="font-family:arial;">o be sure what the future holds for this new antibiotic, especially compared to much cheaper generic drugs like metronidazole. However, the development of any new antibiotic </span></span><span style=";font-family:&quot;;font-size:10pt;color:black;" ><span style=";font-family:arial;font-size:100%;" >is welcome and development and commercialization of any so called ``narrow spectrum´´ antibiotics is especially encouraging. The company will now have to convince physicians to adopt a totally new strategy to treating infections; one that includes first making a clear, specific diagnosis and then using a drug designed to treat only the one diagnosed infection and not selecting a ``shotgun´´ approach to all possible infectious agents. If they are successful this should both increase the use of this antibiotic and help to combat excessive, non-specific antibiotic use by training physicians to think differently about the use of antibiotics. This includes considering the development of resistance as a major outcome variable in antibiotic selection. Such thinking can only be welcomed given the rapidly developing rates of multidrug antibiotic resistance which is due at least in part to the overuse of broad spectrum antibiotics.</span><o:p></o:p></span></p>APUAhttp://www.blogger.com/profile/08697038324333876545noreply@blogger.com1tag:blogger.com,1999:blog-6297038928525377502.post-84983004809930339072010-11-18T10:38:00.004-05:002010-11-18T10:53:29.276-05:00What does the general public actually know about antibiotics and their activity?<a href="http://1.bp.blogspot.com/_RnUenXGH7og/TOVLYPnh8vI/AAAAAAAAAGI/hOQevJH2mJE/s1600/Picture1.png"></a> <div><em><span style="font-family:arial;">In observance of the ECDC's </span><a href="http://www.blogger.com/antibiotic.ecdc.europa.eu"><span style="font-family:arial;">Antibiotic Awareness Day </span></a><span style="font-family:arial;">today, November 18, we asked </span><a href="http://superbugsanddrugs.blogspot.com/p/expert-panel-members.html"><span style="font-family:arial;">Dr. Cliodna McNulty</span></a><span style="font-family:arial;">, Medical Microbiologist and head of the Health Protection Agency's PCU, to share her thoughts on what the British public knows about antibiotics.</span></em></div><br /><div><span style="font-family:arial;"><a href="http://3.bp.blogspot.com/_RnUenXGH7og/TOVLhUHeYNI/AAAAAAAAAGQ/cD2ePuTLxGU/s1600/Picture1.png"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 114px; FLOAT: left; HEIGHT: 152px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5540917952257089746" border="0" alt="" src="http://3.bp.blogspot.com/_RnUenXGH7og/TOVLhUHeYNI/AAAAAAAAAGQ/cD2ePuTLxGU/s200/Picture1.png" /></a>I have been involved in three large household surveys in Britain finding out what the general public think about antibiotics and resistance. The public's attitudes have changed little over the last 7 years. Reassuringly, most of the general public agree that overuse of antibiotics increases resistance, and that antibiotic resistance is increasing. Respondents also know the principles of prudent antibiotic use, as very few disagreed with the statement, "A course of antibiotics should always be completed" and the same percentage didn't agree that "Antibiotics should not be taken unnecessarily." </span></div><br /><div><span style="font-family:arial;"></span></div><div><span style="font-family:arial;">However, despite many public campaigns the use of antibiotics hasn't changed. A similar number in 2009 to that of 2003 reported having an antibiotic in the past year. Respondents were less knowledgeable about whether antibiotics were active against coughs and colds, viruses, bacterial and our normal flora. A third think that "Antibiotics work on most coughs and colds" and more think that "Antibiotics can kill viruses." This indicates that there are a substantial group of the British public who believe that antibiotics will be of value when they have a cough or cold and are therefore still likely to request antibiotics from clinicians when they have these conditions. </span></div><br /><div><span style="font-family:arial;">In future antibiotic educational campaigns, it may be better to discuss the need for antibiotics in relation to the severity of infection or syndrome, rather than the type of microbes (be they bacteria or viruses) responsible.</span><br /><br /></div><div><span style="font-family:arial;">What are your thoughts and ideas?</span></div>APUAhttp://www.blogger.com/profile/08697038324333876545noreply@blogger.com1tag:blogger.com,1999:blog-6297038928525377502.post-56487751573802134162010-11-15T10:03:00.017-05:002010-11-17T16:00:19.375-05:00It's Time to Get Smart About Antibiotics<div align="justify"><span style="COLOR: rgb(0,0,0);font-size:100%;" ><i><span style="font-family:arial;color:#333333;">This guest blog was written by </span><a style="FONT-FAMILY: arial" href="http://superbugsanddrugs.blogspot.com/p/expert-panel-members.html"><span style="color:#333333;">Jean Patel</span></a><span style="color:#333333;"> <span style="font-family:arial;">, PhD, D(ABMM), Deputy Director, Office of Antimicrobial Resistance for Centers for Disease Control and Prevention</span><?xml:namespace prefix = o /><o:p></o:p></span></i></span><span style="color:#333333;"> </span></div><p style="LINE-HEIGHT: normal; MARGIN-BOTTOM: 0pt" class="MsoNormal" align="justify"><span style="font-size:100%;color:#333333;"><b><o:p></o:p></b></span></p><p style="LINE-HEIGHT: normal; MARGIN-BOTTOM: 0pt; COLOR: rgb(0,0,0)" class="MsoNormal" align="justify" face="arial"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_RnUenXGH7og/TOQ-AT746DI/AAAAAAAAAGA/wohKcV3y8C4/s1600/Jean%2BPatel.JPG"><span style="color:#333333;"><img style="MARGIN: 0pt 10px 10px 0pt; WIDTH: 100px; FLOAT: left; HEIGHT: 144px; CURSOR: pointer" id="BLOGGER_PHOTO_ID_5540621616644941874" border="0" alt="" src="http://4.bp.blogspot.com/_RnUenXGH7og/TOQ-AT746DI/AAAAAAAAAGA/wohKcV3y8C4/s200/Jean%2BPatel.JPG" /></span></a><span style="font-family:arial;font-size:100%;"><span style="color:#333333;">When I began my career in antimicrobial resistance at the Centers for Disease Control and Prevention (</span><a href="http://www.cdc.gov/"><span style="color:#333333;">CDC</span></a><span style="color:#333333;">), c</span></span><span style="font-family:arial;font-size:100%;"><span style="color:#333333;">ephalosporin-resistant <i>Enterobacteriaceae</i><span style="font-size:0;"> </span>and </span><a href="http://www.cdc.gov/mrsa"><span style="color:#333333;">methicillin-resistant <i>Staphylococcus aureus</i></span></a><span style="color:#333333;"> were the focus of attention <i>.<span style="font-size:0;"> </span></i>In a few short ye</span></span><span style="color:#333333;"><span style="font-family:arial;font-size:100%;">ars, bacterial pathogens have continued to outwit us by changing their ge</span><span style="font-family:arial;font-size:100%;">netic make-up enough to survive nearly all antibiotics that might be considered for treatment. </span></span></p><p style="LINE-HEIGHT: normal; MARGIN-BOTTOM: 0pt" class="MsoNormal" align="justify"><span style="color:#333333;"><span style="font-family:arial;font-size:100%;">In the past 10 years, carbapenems have been the “drugs of last resort” for <i style="FONT-FAMILY: arial">Enterobacteriaceae</i>. However, today we have identified carbapenem-resistant <i>Enterobacteriaceae</i> (CRE), which carry an enzyme called the <i>Klebsiella pneumoniae</i> carbapenemase (KPC), in at least 35 states and globally. Most recently, CRE with new mechan</span><span style="font-family:arial;font-size:100%;"><span style="font-family:arial;">isms of resistance (called </span><a style="FONT-FAMILY: arial" href="http://blogs.cdc.gov/safehealthcare/?p=808">NDM-1</a><span style="font-family:arial;"> and </span><a style="FONT-FAMILY: arial" href="http://blogs.cdc.gov/safehealthcare/?p=831">VIM</a><span style="font-family:arial;">) were also identified in the United States.</span><span style="font-size:0;"> </span></span></span></p><p style="LINE-HEIGHT: normal; MARGIN-BOTTOM: 0pt" class="MsoNormal" align="justify"><span style="font-size:100%;"><span style="color:#333333;"><span style="font-family:arial;">Now is the time for action. </span><span style="font-family:arial;"></span><span style="font-family:arial;">Antibiotics are a shared resource – and becoming a scarce resource.</span><span style="font-family:arial;"> </span><span style="font-family:arial;">Appropriate use of existing antibiotics can limit the spread of antibiotic resistance, preserving antibiotics for the future.</span></span></span></p><p style="LINE-HEIGHT: normal; MARGIN-BOTTOM: 0pt" class="MsoNormal" align="justify"><span style="font-size:100%;"><span style="color:#333333;"><span style="font-family:arial;">On November 15-18, 2010, CDC and our partners will observe </span><i style="FONT-FAMILY: arial"><a href="http://www.cdc.gov/getsmart/campaign-materials/week/index.html">Get Smart About Antibiotics Week</a>, </i><span style="font-family:arial;">in an effort to focus attention on improving antibiotic use as a key effort to reduce antibiotic resistance. The U.S. observance will coincide with the </span></span><a style="FONT-FAMILY: arial" href="http://ecdc.europa.eu/en/EAAD/Pages/Home.aspx/"><span style="color:#333333;">European</span></a><span style="color:#333333;"><span style="font-family:arial;"> and Canadian antibiotic awareness days, November 18, 2010. In conjunction with Get Smart Week 2010, CDC will unveil its new </span><i style="FONT-FAMILY: arial"><a href="http://www.cdc.gov/getsmart">Get Smart for Healthcare</a></i><span style="font-family:arial;"> campaign focused on improving antibiotic use in hospitals and long-term care facilities. Improving antibiotic use in in-patient settings can improve cure rates and reduce </span><i><span style="font-family:arial;">Clostridium difficile.</span></i></span></span></p><p style="LINE-HEIGHT: normal; MARGIN-BOTTOM: 0pt" class="MsoNormal" align="justify"><span style="font-family:Arial;font-size:100%;color:#333333;">Together, we can address this global resistance threat. By leveraging our collective resources towards preserving these vital therapies for the future, we can protect patients and save lives.</span></p>APUAhttp://www.blogger.com/profile/08697038324333876545noreply@blogger.com2tag:blogger.com,1999:blog-6297038928525377502.post-76565467477122629232010-11-15T10:00:00.022-05:002010-11-17T16:00:40.562-05:00Welcome to APUA's new blog, "Superbugs and Drugs"®!<p style="COLOR: rgb(0,0,0);font-family:times new roman;" class="MsoNormal" align="justify" ><span style="font-family:arial;"><span style="color:#333333;"><span style="font-size:100%;">Antibiotics were long considered “miracle drugs,” capable of saving lives from bacterial infections once considered fatal. However, decades of misuse and overuse have led to the emergence of antibiotic-resistant strains of bacteria invulnerable to many of the drugs we have available today. <?xml:namespace prefix = o /><o:p></o:p></span><span style="font-size:100%;"><b><span style="font-size:0;"><o:p></o:p></span></b></span></span></span><span style="font-family:arial;font-size:100%;"><span style="color:#333333;">Since 1981, <em style="font-family:arial;"><span style="FONT-STYLE: normal">APUA</span></em> has promoted improved antimicrobial access and more appropriate use with the goal of “preserving the power of antibiotics”®. We accomplish our mission by conducting antimicrobial resistance research, education, and advocacy at the grassroots, national and global levels.<br /></span></p></span><p style="COLOR: rgb(0,0,0);font-family:times new roman;" class="MsoNormal" align="justify" ><span style="font-family:arial;font-size:100%;color:#333333;">By extending into the blogosphere, APUA experts intend to serve as a global platform to provide insights and provoke your responses on the impact of antibiotic resistance and strategies for improving antibiotic access and use. We will feature entries from the APUA Staff and our Expert Panel, which consists of selected members of our Scientific Advisory Board, APUA chapter leaders, and other experts in this field. We encourage you to join in the discussion.</span></p><p style="COLOR: rgb(0,0,0);font-family:times new roman;" class="MsoNormal" align="justify" ><span style="font-family:arial;font-size:100%;color:#333333;">Thank you,</span></p><p style="COLOR: rgb(0,0,0);font-family:times new roman;" class="MsoNormal" align="justify" ><span style="font-family:arial;font-size:100%;color:#333333;">Kathleen Young, Executive Director and Stuart B. Levy, MD, President</span></p>APUAhttp://www.blogger.com/profile/08697038324333876545noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-26598127884711217882010-05-04T10:36:00.007-04:002010-11-17T15:55:50.692-05:00Agricultural, Environmental, and Community Sources of Resistance<div style="TEXT-ALIGN: justify; COLOR: rgb(0,0,0)font-family:times new roman;" ><span style="font-size:100%;"><span style="font-family:arial;">A new </span><a href="http://www.ajtmh.org/cgi/content/full/82/5/879"><span style="font-family:arial;">study</span></a><span style="font-family:arial;"> from the Johns Hopkins </span><a href="http://www.jhsph.edu/?t=1"><span style="font-family:arial;">Bloomberg School of Public Health</span></a><span style="font-family:arial;"> gives further evidence that antibiotic resistance is only just the result of antibiotic use and abuse in human medicine, but that a reservoir of resistance, from farm animals and environmental contamination, is a significant contributor as well. A team of scientists led by </span><a href="http://faculty.jhsph.edu/default.cfm?faculty_id=353"><span style="font-family:arial;">Henry D. Kalter</span></a><span style="font-family:arial;"> examined </span><a href="http://www.cdc.gov/ecoli/"><span style="FONT-STYLE: italic;font-family:arial;" >E. coli</span></a><span style="font-family:arial;"> samples in more than 500 young Peruvian children, then compared resistance levels to a range of factors in the children's households and communities. The results are published in this month's issue of the</span><a href="http://www.ajtmh.org/"><span style="font-family:arial;"> American Journal of Tropical Medicine and Hygiene</span></a><span style="font-family:arial;">.As would be expected, the children's own use of antibiotics, as well as family member use, was a significant risk factor for their carriage of drug-resistant bacteria. Applying an antibiotic to a population of bacteria selects for the resistant ones to survive, and though these bacteria might not immediately cause disease, they may pass these genes to other species of bacteria, for example through </span><a href="http://www.hhmi.org/biointeractive/animations/conjugation/conj_frames.htm"><span style="font-family:arial;">conjugation</span></a><span style="font-family:arial;">.<br /><br />But the authors also found evidence for a transfer of resistant bacteria between food animals and humans - specifically, through market chicken raised with antibiotics. Living in a community with more families raising chickens, as opposed to buying their chicken at a market, was a significant protective factor against children's carriage of resistant bacteria. Market chickens were also significanlty more likely to carry antibiotic-resistant bacteria than home-raised chickens, and presumably transferred this resistance to humans in the community though the food chain or direct contact. </span><a href="http://www2.massgeneral.org/id/labs/ryan/"><span style="font-family:arial;">Dr. Edward T. Ryan</span></a><span style="font-family:arial;">, president of the American Society of Tropical Medicine and Hygiene, explained the study's importance in this respect:</span></span></div><div style="TEXT-ALIGN: justify; COLOR: rgb(0,0,0)font-family:times new roman;" ><blockquote><span style="font-family:arial;font-size:100%;">"[The study] improves our understanding of the growing global public health threat of antibiotic resistant organisms, and underscores the critical role that antibiotic use in animals plays in contributing to this threat. The vast majority of the tons and tons of antibiotics ingested each year on this planet are administered to livestock and animals. This study clearly shows that such use comes with a very real cost to human health."</span></blockquote></div><div style="TEXT-ALIGN: justify; COLOR: rgb(0,0,0)font-family:times new roman;" ><span style="font-family:arial;"><span style="font-size:100%;">The study also identified a link between environmental contamination with antibiotic-resistant bacteria and increased carriage of resistant </span><span style="FONT-STYLE: italic;font-size:100%;" >E. coli</span></span><span style="font-family:arial;font-size:100%;">. In fact, as the authors write,<br /></div></span><blockquote style="TEXT-ALIGN: justify; COLOR: rgb(0,0,0)font-family:times new roman;" ><span style="font-family:arial;"><span style="font-size:100%;">"In these poor communities in a developing country, with inadequate protection of excreta and water, contamination of the environment with antibiotic-resistant bacteria appeared to play at least as great a role in children's carriage of resistant </span><span style="FONT-STYLE: italic;font-size:100%;" >E. coli</span><span style="font-size:100%;"> as did the children's own antibiotic use." </span></span></blockquote><div style="TEXT-ALIGN: justify; COLOR: rgb(0,0,0)font-family:times new roman;" ><span style="font-family:arial;font-size:100%;">These results corroborate the need for a big-picture approach to addressing antibiotic resistance in both developing and developed nations. The authors cite the intensive use of antibiotics on chickens raised in Peru as a factor contributing to resistance in humans there, but this is hardly an isolated issue - millions of pounds of antibiotics are administered to farm animals every year in the </span><span style="font-family:arial;font-size:100%;">United States, and the presence of an environmental and agricultural reservoir of resistance genes is a threat to the success of antibiotic treatment everywhere.</span></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-22490405215591067192010-04-08T11:28:00.010-04:002010-11-17T15:56:23.970-05:00VRSA in Philadelphia<div style="TEXT-ALIGN: justify; COLOR: rgb(0,0,0)font-family:times new roman;" ><span style="font-size:100%;"><span style="font-family:arial;">The first U.S. case of </span><a href="http://www.cdc.gov/ncidod/dhqp/ar_visavrsa_FAQ.html"><span style="font-family:arial;">vancomycin-resistant </span></a></span><span style="FONT-STYLE: italic;font-size:100%;" ><a href="http://www.cdc.gov/ncidod/dhqp/ar_visavrsa_FAQ.html"><span style="font-family:arial;">Staphylococcus aureus</span></a><span style="font-family:arial;"> </span></span><span style="font-size:100%;"><span style="font-family:arial;">(VRSA) since 2007 has been identified in a University of Pennsylvania hospital, according to a Philadelphia Inquirer </span><a style="FONT-FAMILY: times new roman" href="http://www.philly.com/philly/news/local/90194387.html"><span style="font-family:arial;">article</span></a><span style="font-family:arial;"> published today. VRSA is an even more formidable but rare cousin of </span><a style="FONT-FAMILY: times new roman" href="http://www.cdc.gov/mrsa/"><span style="font-family:arial;">MRSA</span></a><span style="font-family:arial;">, an infection that kills over 19,000 people in the U.S. every year.<br /><br />The most recent case is a woman on kidney dialysis who was infected both with MRSA and with </span><a style="FONT-FAMILY: times new roman" href="http://www.cdc.gov/ncidod/dhqp/ar_vre.html"><span style="font-family:arial;">vancomycin-resistant enterococci</span></a><span style="font-family:arial;"> (VRE). Vancomycin is used to prevent infection in kidney patients, exposing them to resistance risks. In this case, MRSA bacteria acquired resistance to vancomycin, the drug commonly used to treat MRSA, through genetic transfer from VRE bacteria.<br /><br />VRSA infections are worrisome because vancomycin is often used as a drug of last resort when other antibiotics fail. Although VRSA is still susceptible to a limited number of antibiotics, these treatments are more costly and invasive than vancomycin and can have serious side effects. Like MRSA, VRSA can be transferred between individuals directly or through objects that have come into contact with infected patients, making it a potentially dangerous force in healthcare settings.<br /></span></span></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-76746526091031863142010-04-07T14:32:00.015-04:002010-11-17T15:56:53.925-05:00Long-Term Consequences of Antibiotic Treatment<div style="TEXT-ALIGN: justify" class="MsoNormal"><span style="font-size:100%;"><span style="font-family:arial;">One week of antibiotic treatment can impact commensal bacteria populations and genetic resistance for years, according to a new </span><a href="http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0009836"><span style="font-family:arial;">study</span></a><span style="font-family:arial;"> published in the Public Library of Science journal, </span><a href="http://www.plosone.org/home.action"><span style="font-family:arial;">PLoS ONE</span></a><span style="font-family:arial;">. A team of researchers led by Hedvig E. Jakobsson of the </span><a href="http://www.smittskyddsinstitutet.se/in-english/"><span style="font-family:arial;">Swedish Institute for Infectious Disease Control</span></a><span style="font-family:arial;"> observed the changes brought on by antibiotics prescribed for gastric and duodenal ulcers and found that the balance of commensal bacteria, particularly in the gut, was still disturbed four years following treatment. </span></span></div><div style="TEXT-ALIGN: justify" class="MsoNormal"><span style="font-size:100%;"><span style="font-family:arial;">The authors followed three patients with ulcers caused by the bacterium </span><a href="https://health.google.com/health/ref/Helicobacter+pylori"><i><span style="font-family:arial;">Helicobacter pylori</span></i></a><span style="font-family:arial;"> and three controls. The case patients were treated twice a day for seven days with the standard course of antibiotics: metronidazole, clarithromycin, and omeprazole. In case patients, bacterial diversity in fecal samples decreased immediately following treatment, with a particular decline in Actinobacteria. In addition, the initially low abundance of </span></span><span style="font-family:arial;"><span style="FONT-STYLE: italic;font-size:100%;" >erm(B)</span><span style="font-size:100%;"> genes that code for antibiotic resistance increased by 3-5 orders of magnitude in case patients following treatment.</span></span></div><div style="TEXT-ALIGN: justify" class="MsoNormal"><span style="font-family:arial;font-size:100%;">One year after treatment, <i>erm(B)</i> genes were still present at 1,000 times their pre-treatment level, and continued to be elevated four years post-treatment. According to the authors, this increase in resistance could be a result of horizontal gene transfer between bacteria or multiplication of existing drug-resistant bacteria following changes in commensal populations. </span></div><div style="TEXT-ALIGN: justify" class="MsoNormal"><span style="font-family:arial;font-size:100%;">There were also changes in the throat microbiota of patients receiving antibiotic treatment, but this population showed more stability than gut bacteria.<br /></span></div><div style="TEXT-ALIGN: justify" class="MsoNormal"><span style="font-family:arial;font-size:100%;">Commensal intestinal bacteria are essential to the human immune system, and disruption of this population has potentially dangerous and long-lasting consequences. While calling for larger studies to back up their findings, the researchers emphasized the importance of limited and prudent antibiotic use to prevent the spread of potentially pathogenic antibiotic-resistant bacteria.<br /></span></div><span style="COLOR: rgb(0,0,0);font-size:100%;" ></span>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-72347259168468319352010-03-31T13:21:00.020-04:002010-11-15T10:37:41.496-05:00Tracing the Roots of MRSA<div style="text-align: justify; font-family: times new roman; color: rgb(0, 0, 0);"><span style="font-size:100%;">A study published earlier this year used genomic analysis to trace one of the most common strains of MRSA, ST239, back to the introduction of widespread antibiotic usage in 1960's Europe. The genomic data also gave researchers insight into the transmission of MRSA on both local and global levels.</span></div><div style="text-align: justify; font-family: times new roman; color: rgb(0, 0, 0);"><span style="font-size:100%;">Led by <a href="http://research.ncl.ac.uk/microbial_eukaryotes/simonr_harris.html">Dr. Simon Harris</a> of the <a href="http://www.sanger.ac.uk/">Wellcome Trust Sanger Institute</a>, the authors analyzed 63 ST239 isolates, 43 of those from different locations around the globe over a period from 1982-2003. By determining the presence <a href="http://www.ncbi.nlm.nih.gov/About/primer/snps.html">single nucleotide polymorphisms</a> (SNPs), small variable regions in an organism's genome, in each isolate, they were able to create a phylogeny that maps out the likely origin of each strain (see image).<br /><br /><a href="http://4.bp.blogspot.com/_PpFqzlu2XFY/S7OQTdbx_aI/AAAAAAAAAFc/fTg4EKxSYeg/s1600/MRSA+phylogeny.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" id="BLOGGER_PHOTO_ID_5454862237668867490" src="http://4.bp.blogspot.com/_PpFqzlu2XFY/S7OQTdbx_aI/AAAAAAAAAFc/fTg4EKxSYeg/s320/MRSA+phylogeny.gif" style="margin: 0px auto 10px; cursor: pointer; display: block; height: 212px; text-align: center; width: 320px;" border="0" /></a></span><span style="font-size:100%;"><br />The completed puzzle told the researchers that the isolates clustered by location, as would be expected, but that some isolates seemed to have been transmitted between two locations, perhaps by a single individual. For example, isolates from a MRSA <a href="http://apps.isiknowledge.com/InboundService.do?Func=Frame&amp;product=WOS&amp;action=retrieve&amp;SrcApp=Highwire&amp;UT=000243597700006&amp;SID=4C9pBj5eHFOcbfiIbmj&amp;Init=Yes&amp;SrcAuth=Highwire&amp;mode=FullRecord&amp;customersID=Highwire&amp;DestFail=http%3A%2F%2Fwww.isiknowledge.com%3FDestApp%3DCEL%26DestParams%3D%253Faction%253Dretrieve%2526mode%253DFullRecord%2526product%253DCEL%2526UT%253D000243597700006%2526customersID%253DHighwire%26e%3DxVgiu2PdUbTQZlaWQbyWaPyklORWeaRIdtO8UPDfqLq1dTFR_UA7BGmClsuMy_I3%26SrcApp%3DHighwire%26SrcAuth%3DHighwire&amp;smartRedirect=yes">outbreak in a London hospital</a> were part of the same genetic cluster that belonged to Thai isolates, indicating the likelihood of a "single intercontinental transmission event."<br /><br />The phylogeny was created to limit the number of common SNPs that would have come about by <a href="http://www.sciencedaily.com/articles/c/convergent_evolution.htm">convergent evolution</a> - when a mutation develops multiple times in different branches of a genetic tree. Of the SNPs that did indicate convergent evolution, over 25 percent of these were genes involved with resistance to currently-used antibiotics, showing that clinical practice of drug use is a major driver of evolution towards resistant bacteria.<br /><br />Finally, the analysis allowed the researchers to calculate the rate of mutation of ST239 bacteria at one core SNP every six weeks. Using this figure, they were able to trace a common ancestor for all of the isolates to one strain originating in Europe in the mid-to-late 1960's. This coincides with the beginning of the popular use of antibiotics in Europe, and with the first identified MRSA cases there.<br /><br />This study may be most useful for the technique it uses to trace resistant isolates through time and location. Combined with improved global surveillance of MRSA, these methods may be used to detect introduction of new strains and target the needed forms of diagnostics and interventions, the authors write.<br /><br />Coauthor <a href="http://www.research-horizons.cam.ac.uk/insideout/-p-professor-sharon-peacock--p-.aspx">Dr. Sharon Peacock</a> told <a href="http://www.telegraph.co.uk/health/healthnews/7045108/Widespread-antibiotic-use-in-1960s-sparked-MRSA.html"><span style="font-style: italic;">The Telegraph</span></a>:<br /></span><blockquote><span style="font-size:100%;">"We are now able to discriminate between one strain and another, even where they are very closely related. Our research should inform global surveillance strategies to track the spread of MRSA.</span></blockquote><blockquote><span style="font-size:100%;">"The implications for public health are clear: this technology represents the potential to trace transmission pathways of MRSA more definitively so that interventions or treatments can be targeted with precision and according to need."</span></blockquote></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-38272984314270715742010-03-24T15:27:00.009-04:002010-03-24T16:24:34.031-04:00Bedside Reading<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_PpFqzlu2XFY/S6pt7NzhRNI/AAAAAAAAAFM/a4W1RMhQ_0w/s1600/Superbug+book.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 200px; height: 303px;" src="http://2.bp.blogspot.com/_PpFqzlu2XFY/S6pt7NzhRNI/AAAAAAAAAFM/a4W1RMhQ_0w/s320/Superbug+book.jpg" alt="" id="BLOGGER_PHOTO_ID_5452291162970866898" border="0" /></a><a href="http://www.marynmckenna.com/home.html"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">Maryn</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_1">McKenna</span></a> is the author of a new book released yesterday, "<a href="http://www.amazon.com/Superbug-Fatal-Menace-Maryn-McKenna/dp/141655727X/ref=sr_1_1?ie=UTF8&amp;s=books&amp;qid=1269459050&amp;sr=8-1"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">Superbug</span>: The Fatal Menace of <span class="blsp-spelling-error" id="SPELLING_ERROR_3">MRSA</span></a>," on the hospital, community, and environmental dangers of <span class="blsp-spelling-error" id="SPELLING_ERROR_4">methicillin</span>-resistant <span style="font-style: italic;">Staphylococcus <span class="blsp-spelling-error" id="SPELLING_ERROR_5">aureus</span></span>. <span class="blsp-spelling-error" id="SPELLING_ERROR_6">McKenna</span>, a science and medical journalist with the University of Minnesota's <a href="http://www.cidrap.umn.edu/">Center for Infectious Disease Research and Policy</a>, discussed the book yesterday on <a href="http://www.npr.org/">NPR</a>'s <span style="font-style: italic;">Fresh Air</span> with Terry Gross. You can listen to the interview <a href="http://www.npr.org/templates/story/story.php?storyId=124999740">here</a> or <a href="http://www.npr.org/templates/transcript/transcript.php?storyId=124999740">read the transcript</a> online.<br /></div><br /><div style="text-align: justify;">In the interview, <span class="blsp-spelling-error" id="SPELLING_ERROR_7">McKenna</span> discusses the increased complication in treating <span class="blsp-spelling-error" id="SPELLING_ERROR_8">MRSA</span> infections due to crossover between what were originally separate <span class="blsp-spelling-error" id="SPELLING_ERROR_9">healthcare</span>-associated and community-associated <span class="blsp-spelling-error" id="SPELLING_ERROR_10">MRSA</span> strains. Now, she says, strains that were typically isolated to the hospital or to community settings (prisons and locker rooms, for example) are showing up in unexpected places and behaving in unexpected ways. As a result, doctors are not sure what the drug-resistance pattern of a given infection is -- and as a result, rely on prescribing the most intense drugs available. She also explains the dangers of low-dose antibiotics in farm animals, and the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">possibility</span> of <span class="blsp-spelling-error" id="SPELLING_ERROR_12">MRSA</span> being transferred from animals to humans. Although she acknowledges that preventing the spread of <span class="blsp-spelling-error" id="SPELLING_ERROR_13">MRSA</span> and the development of resistance in general is difficult given the <span class="blsp-spelling-error" id="SPELLING_ERROR_14">overprescription</span> and overuse of antibiotics, as well as <span class="blsp-spelling-error" id="SPELLING_ERROR_15">MRSA's</span> resilience as an organism, <span class="blsp-spelling-error" id="SPELLING_ERROR_16">McKenna</span> does recommend a few things people can do to protect themselves: wash your hands, make sure your kids shower after sports, and use antibiotics appropriately.<br /><span style="font-size:85%;"><br />Image courtesy of www.npr.org</span><br /></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-68631512840077876282010-03-23T15:59:00.019-04:002010-03-23T16:32:37.104-04:00World TB Day<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_PpFqzlu2XFY/S6kkXEKl5gI/AAAAAAAAAE8/oGVmc1TCEeo/s1600-h/World+TB+Day.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 180px; height: 255px;" src="http://1.bp.blogspot.com/_PpFqzlu2XFY/S6kkXEKl5gI/AAAAAAAAAE8/oGVmc1TCEeo/s320/World+TB+Day.jpg" alt="" id="BLOGGER_PHOTO_ID_5451928802582455810" border="0" /></a>March 24 is <a href="http://www.cdc.gov/Features/WorldTBDay/">World TB Day</a>. Tomorrow marks the 128<sup>th</sup> anniversary of the discovery of <i>Mycobacterium tuberculosis</i>, the bacterium that causes tuberculosis, by the German physician and microbiologist <a href="http://nobelprize.org/nobel_prizes/medicine/laureates/1905/koch-bio.html">Robert Koch</a>.<br /></div> <div class="MsoNormal" style="text-align: justify;">Tuberculosis has largely faded from public consciousness in the United States. Annually there are now fewer than 13,000 cases of TB and fewer than 1,000 deaths in the U.S., less than half of the TB burden 30 years ago. But in developing nations, TB is more dangerous than ever, where multidrug-resistant (MDR) strains drain medical and economic resources and kill millions of people.<br /><br />Last week, the <a href="http://www.who.int/en/">World Health Organization (WHO)</a> published a new <a href="http://www.who.int/mediacentre/news/releases/2010/drug_resistant_tb_20100318/en/index.html">report</a> on multidrug- and extensively drug-resistant TB, reporting 440,000 cases of MDR-TB worldwide in 2008. In total, there were 9.4 million new TB cases and 1.8 million TB deaths in 2008.<br /><br />MDR-TB is defined as a strain of tuberculosis that is resistant to at least isoniazid and rifampicin, two first-line TB drugs. It can develop in an individual patient when drugs are misused – as is common with TB treatments because they require months of administration – or when a resistant strain is passed between people. MDR-TB takes longer to treat than drug-susceptible infections, and it also costs a lot more to treat: up to $5,000 per case, compared to $20 for susceptible TB. The WHO reports that in some regions MDR-TB makes up more than a quarter of new TB diagnoses, and almost half of all cases come from China and India. Mistreatment of MDR-TB can lead to an even more dangerous and costly condition, extensively drug-resistant (XDR) tuberculosis, which is resistant to both first- and second-line treatments.<br /><br />With resistant TB strains persisting and representing a growing share of new diagnoses, development of new treatments is essential. Last week, the <a href="http://www.tballiance.org/home/home.php">Global Alliance for TB Drug Development</a>, the <a href="http://www.c-path.org/">Critical Path Institute</a> and the <a href="http://www.gatesfoundation.org/">Bill &amp; Melinda Gates Foundation</a><cite></cite> announced a new initiative that aims to make these treatments available sooner. The Critical Path to TB Drug Regimens will test combinations of early development TB drugs from a range of pharmaceutical companies, including Johnson &amp; Johnson, Pfizer and GlaxoSmithKline in an attempt to identify the best possible treatment regimens coming out of the pipeline (read the press release <a href="http://www.prnewswire.com/news-releases/global-partners-join-forces-to-speed-development-of-new-tb-drug-combinations-88386012.html">here</a>). This could drastically reduce the time to market for these drug regimens, but in order for new drugs to remain effective they must be used in a way that prevents the development of resistance. The U.S. battle with TB may be winding down, but it is only intensifying worldwide.<br /><br />See the CDC website for information on World TB Day <a href="http://www.cdc.gov/tb/events/WorldTBDay/2010/state_activities.htm#International">activities</a> as well as <a href="http://www2c.cdc.gov/ecards/message/message.asp?cardid=432">e-Cards</a> to spread TB awareness.<br /><br /><span style="font-size:85%;">Image courtesy of www.cdc.gov</span><br /></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-61331868892164568892010-03-22T10:39:00.013-04:002010-04-10T09:39:07.167-04:00More on CDIs<div style="text-align: justify;">If there is a pathogenic face to antibiotic resistance, it's <span class="blsp-spelling-error" id="SPELLING_ERROR_0">MRSA</span>, or <span class="blsp-spelling-error" id="SPELLING_ERROR_1">methicillin</span>-resistant <span style="font-style: italic;">Staphylococcus <span class="blsp-spelling-error" id="SPELLING_ERROR_2">aureus</span></span>. It can be gross and gory, affects both the elderly in nursing homes and children on athletic teams, and causes more deaths in the U.S. each year than AIDS. But is it the infection you should be most worried about during a hospital stay?<br /><br />New <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">research</span> suggests that<span style="font-style: italic;"><span style="font-style: italic;"><span style="font-style: italic;"> </span></span><span class="blsp-spelling-error" id="SPELLING_ERROR_4">Clostridium</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_5">difficile</span> </span>infections (<span class="blsp-spelling-error" id="SPELLING_ERROR_6">CDIs</span>) may be overtaking <span class="blsp-spelling-error" id="SPELLING_ERROR_7">MRSA</span> as the most threatening of the antibiotic-resistant infections the American <span class="blsp-spelling-error" id="SPELLING_ERROR_8">healthcare</span> system faces. Scientists affiliated with <a href="https://dicon.mc.duke.edu/modules/dicon_about/index.php?id=1">Duke's Infection Control Outreach Network</a><a href="https://dicon.mc.duke.edu/modules/dicon_about/index.php?id=1"> (<span class="blsp-spelling-error" id="SPELLING_ERROR_9">DICON</span>)</a> presented a <a href="http://shea.confex.com/shea/2010/webprogram/Paper2801.html">study</a> at last weekend's <a href="http://www.decennial2010.com/">Fifth Decennial International Conference on <span class="blsp-spelling-error" id="SPELLING_ERROR_10">Healthcare</span>- Associated Infections</a> that found <span class="blsp-spelling-error" id="SPELLING_ERROR_11">CDI</span> rates in excess of <span class="blsp-spelling-error" id="SPELLING_ERROR_12">MRSA</span> infections in community hospitals in the Southeast United States. In this group of 30 hospitals, which were monitored from January 2008 through June 2009, <span style="font-style: italic;">C. <span class="blsp-spelling-error" id="SPELLING_ERROR_13">difficle</span></span> was the leading <span class="blsp-spelling-error" id="SPELLING_ERROR_14">healthcare</span>-associated infection (<span class="blsp-spelling-error" id="SPELLING_ERROR_15">HAI</span>). <span style="font-style: italic;">C. <span class="blsp-spelling-error" id="SPELLING_ERROR_16">difficile</span></span> beat out <span class="blsp-spelling-error" id="SPELLING_ERROR_17">MRSA</span>, 612 cases (0.26 per 1,000 patient-days) to 505 cases (0.22 per 1,000 patient-days).<br /><br />Previous studies also suggest that the mortality rate for <span class="blsp-spelling-error" id="SPELLING_ERROR_18">CDI</span> is higher than <span class="blsp-spelling-error" id="SPELLING_ERROR_19">MRSA</span>. But it's also possible that <span class="blsp-spelling-error" id="SPELLING_ERROR_20">CDI</span> is more preventable, because it is so closely linked to previous antibiotic usage in each individual patient, and largely confined to <span class="blsp-spelling-error" id="SPELLING_ERROR_21">healthcare</span> settings (except in pediatrics - see "<span class="blsp-spelling-error" id="SPELLING_ERROR_22">CDIs</span> Increasing in Children" below). This is one case where effective infection control and prevention strategies, as well as public education, could go a long way. You can learn more about<span style="font-style: italic;"> C. <span class="blsp-spelling-error" id="SPELLING_ERROR_23">difficile</span></span> from the <a href="http://www.cdc.gov/ncidod/dhqp/id_Cdiff.html">CDC</a> and the <a href="http://www.mayoclinic.com/health/c-difficile/DS00736">Mayo Clinic</a>.<br /></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-40977713328171494882010-03-19T15:04:00.008-04:002010-03-22T11:25:14.037-04:00CDIs Increasing in Children<div class="MsoNormal" style="text-align: justify;">New research published in <a href="http://www.cdc.gov/ncidod/EID/index.htm">Emerging Infections Diseases</a> suggests a more than 80 percent increase in the number of childhood hospitalizations due to <a href="http://www.cdc.gov/ncidod/dhqp/id_Cdiff.html"><i>Clostridium difficile</i></a><i> </i>between 1997 and 2006. The study (ahead of print, see pdf <a href="http://www.cdc.gov/eid/content/16/4/pdfs/09-0680.pdf">here</a>), led by <a href="http://www.umass.edu/sphhs/outreach/MaryaZilberbergMDMPH.html">Marya Zilberberg</a>, drew statistics from multiple databases of pediatric hospitalizations. In the ten years examined, the number of children hospitalized for <i>C. difficile</i> infection (CDI) increased from 7.24 per 10,000 hospitalizations to 12.80. In 1997, there were 4,626 pediatric hospitalizations for CDI, compared to 8,417 in 2006 – an average increase of 9 percent each year.<br /><br />In that time, practitioners have also recognized the spread of a more virulent form of <i>C. difficile</i> that causes more hospitalizations and has elevated case-fatality rates. CDIs are almost exclusively hospital-acquired; they do not affect healthy people in the community. <i>C. difficile </i>is a common, generally harmless commensal bacteria. But in patients taking long-term, low doses of antibiotics, changes in bacterial communities can offset the microbial balance and allow <i>C. difficile</i> to run rampant in the system. And the symptoms of CDI – diarrhea and a range of intestinal conditions – make it especially dangerous in a hospital setting, where it can be unwittingly transferred by patients and practitioners or through contamination in the environment. CDI is costly for both patients and hospitals – an IDSA/SHEA <a href="http://www.journals.uchicago.edu/doi/abs/10.1086/591065">report</a> cites a $3.2 billion annual price tag for U.S. hospitals for CDI management, and a 16.7% one-year mortality rate for patients. It’s also complicated to eliminate from the environment because as a spore-forming bacteria it can withstand treatment with alcohol-based cleaning products.<br /><br /></div><div style="text-align: justify;"></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_YU9DUZHbrgg/S6PKNNZHjJI/AAAAAAAAASA/uvDtPEgAKqE/s1600-h/aaaa.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img src="http://1.bp.blogspot.com/_YU9DUZHbrgg/S6PKNNZHjJI/AAAAAAAAASA/uvDtPEgAKqE/s400/aaaa.jpg" border="0" height="295" width="400" /></a></div><div class="MsoNormal" style="text-align: justify;"><div style="text-align: left;"><div style="text-align: justify;"><br />But while CDI in adults consistently shows up in healthcare settings following antibiotic treatment, its epidemiology appears to be different in children. Many cases of pediatric CDI, Zilberberg and her colleagues explain, are community-based in origin with no recent history of antibiotic treatment. In addition, many neonates are colonized with <i>C. difficile</i> but do not get sick, whereas cases of CDI jump to 32.01 per 10,000 hospitalizations for non-newborns less than one year old and peak in children aged one to four. In light of their observed increases in CDI and as a more virulent strain predominates, the authors call for more research on <i>C. difficile</i>, especially targeted at this non-newborn infant population.</div></div></div><div class="MsoNormal"><o:p></o:p></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-41518481355364930112010-03-17T15:51:00.008-04:002010-03-17T16:11:15.916-04:00IDSA Calls for 10 New Antibacterial Drugs by 2020<span style="font-style: italic;">“Microbial evolution causing antibiotic resistance is constant; our collective efforts at antibiotic discovery must be constant.”<br /><br /></span><div class="MsoNormal" style="text-align: justify;"></div><div style="text-align: justify;"></div><div class="MsoNormal" style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_PpFqzlu2XFY/S6E0Q8MYTsI/AAAAAAAAAEs/n1HzpsixVv4/s1600-h/badbugs.gif"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 120px; height: 98px;" src="http://3.bp.blogspot.com/_PpFqzlu2XFY/S6E0Q8MYTsI/AAAAAAAAAEs/n1HzpsixVv4/s320/badbugs.gif" alt="" id="BLOGGER_PHOTO_ID_5449694489735614146" border="0" /></a> In the 2010 April 15 issue of Clinical Infectious Diseases, the <a href="http://www.idsociety.org/">Infectious Diseases Society of America</a> outlines its “<a href="http://www.journals.uchicago.edu/doi/full/10.1086/652237">10 x ’20 Initiative</a>,” calling for a global effort to develop 10 new antibiotics by 2020. The initiative originated in a letter written to U.S. President Barack Obama and Swedish Prime Minister Fredrick Reinfeldt urging the creation of an Antibacterial Drug Development Work Group following their announcement of an agreement to establish a transatlantic task force on antimicrobial resistance at their November 2009 <a href="http://www.whitehouse.gov/the-press-office/us-eu-joint-declaration-and-annexes">summit</a>. IDSA calls for a commitment from a diverse group of U.S. and international leaders, healthcare providers and researchers, public health organizations, and patients themselves.<br /><br />The policy article references the lack of incentives for pharmaceutical companies to develop new antibiotics (see “Drug Development: Where are the New Antibiotics?” below) and sets the stakes for its challenge:<br /><br />“The antibiotic pipeline problem may change the practice of medicine as we know it. Advanced interventions currently taken for granted – for example, surgery, cancer treatment, transplantation, and care of premature babies – could become impossible as antibiotic options become fewer.”<br /><br />IDSA also points to the need to develop better diagnostic tests that will allow doctors to quickly distinguish between drug-resistant and drug-susceptible infections, and treat patients accordingly. This would help halt the spread of drug-resistant infections in healthcare facilities and allow for newer antibiotics to be saved for the most dangerous resistant cases. You can read more on IDSA’s “Bad Bugs No Drugs” campaign, including patient stories of drug-resistant infections <a href="http://www.idsociety.org/badbugsnodrugs.html">here</a>.<br /></div>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-43489219485519199332010-03-16T13:19:00.021-04:002010-03-18T11:50:30.599-04:00The Microbiology of Antibiotic Resistance, Part 2: Bacterial Reproduction and Mechanisms of Resistance<div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Bacteria populate some of the most extreme and diverse environments in the world – from hydrothermal vents, located thousands of feet below sea level, to deep within the human body. This ability to cope with and adapt to ever changing environments in order to survive can be partially attributed to favorable evolutionary traits, which allow bacteria to quickly mutate and acclimate to new a environmental stressor, such as the presence of an antibiotic. These mechanisms of resistance are either natural (inherent) or acquired resistances&nbsp;(</span><a href="http://www.textbookofbacteriology.net/resantimicrobial_3.html"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">1</span></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">).</span><br /><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">With a natural resistance, bacteria may be resistant to the environmental stressor due to inherent structural or chemical characteristics. For example, a Gram-negative bacteria’s double cell wall acts as a permeability barrier against some antibiotics, preventing the drug’s uptake by the bacteria and thus eliminating its ability to affect the cell.</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Acquired resistance can be further classified into vertical and horizontal gene transfer with vertical transfer temporally preceding horizontal gene transfer. One out of every 10</span><sup><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">8</span></span></sup><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> - 10</span><sup><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: small;">9</span></span></sup><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> chromosomal replications will result in an unlinked point mutation that leads to antibiotic resistance. With the fast growth and high frequency of bacterial replication, it does not take long for resistance to appear in a bacterial population. Once resistance genes develop through mutations, they are transferred to all the bacteria’s progeny during DNA replication. In a stressed environment, with the presence of antibiotics for example, the wild type bacterial genome will not be able to survive and this spontaneous mutation, imparting resistance, will allow the mutant antibiotic-resistant bacteria and its progeny to grow, flourish and overtake the entire bacterial population&nbsp;(</span><a href="http://biogetopics.wordpress.com/2008/11/"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">2</span></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">).</span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Once a bacterium has acquired a favorable spontaneous mutation, it can also pass the mutation onto other non-progeny bacteria through horizontal gene transfer, which involves the lateral transfer of genetic material between individual bacteria of the same of different species. This transfer usually involves the acquisition and maintenance of the supplementary genetic information on accessory DNA pieces termed plasmids.</span><br /><a href="http://4.bp.blogspot.com/_YU9DUZHbrgg/S6JAJdTuK2I/AAAAAAAAAR4/H7PMkRAvnfs/s1600/aa.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><img border="0" height="320" src="http://4.bp.blogspot.com/_YU9DUZHbrgg/S6JAJdTuK2I/AAAAAAAAAR4/H7PMkRAvnfs/s320/aa.png" width="297" /></span></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">These plasmids exist separately from the main bacterial chromosome; carry their own unique genes, sometimes as many as 300; and are able to duplicate themselves independently. Each bacterial cell may have as many as 1000 copies of a single plasmid and are able to have several unique plasmids concurrently. The benefits of this come with the information that plasmids can carry, which allow bacteria to perform new functions and create new products that are not coded in their chromosomal genetics. Some of these new traits will allow bacteria to survive in extreme environments, while others confer important functions to bacteria, such as antibiotic resistance. Many times, two plasmids, frequently ones that carry genes for antibiotic resistance, are able to combine to form one large plasmid or exchange pieces of their DNA to create more diversity on a single plasmid. Thus, a single bacterium can acquire multiple antibiotic resistance genes from one plasmid. </span></div><div class="MsoNormal" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Through the exchange and uptake of different plasmids, one bacterium can gain the ability to survive through a wide variety of environmental stresses. Plasmid exchange occurs in bacteria through horizontal gene transfer, even between distantly related bacteria. When one bacterial cell acquires antibiotic resistance, it can quickly transfer this resistance to several other species of bacteria through one of three common methods: conjuction, the transfer of genetic material, usually a plasmid, through cell-to-cell contact, usually by pili; transformation, the introduction, uptake and expression of foreign genetic material; and transduction the transfer of DNA by a bacteriophage (bacterial virus)&nbsp;(</span><a href="http://www.scq.ubc.ca/from-dyes-to-peptides-the-evolution-of-antibiotic-drugs/"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">3</span></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">).</span></div></div>Lesterhttp://www.blogger.com/profile/02100182509663223294noreply@blogger.com0tag:blogger.com,1999:blog-6297038928525377502.post-85859726329892155102010-03-15T16:00:00.012-04:002010-03-16T09:35:24.684-04:00Drug Development: Where are the New Antibiotics?As resistance to antibiotics continues to develop and spread, the medical community can no longer afford to ignore a distressing reality: the lack of new antibiotics in the development pipeline. Resistance is causing current antibiotics to lose their efficacy, and we are left without viable alternatives. This is largely a result of the regulations and economics of drug development, a process that makes antibiotics undesirable classes of drugs to produce and market.<span style=""> </span> <p style="text-align: justify;" class="MsoNormal"><!--[if !supportEmptyParas]--><!--[endif]--> Drug development is a heavily-regulated, step-by-step process that is meant to ensure that a drug is safe and effective before it appears on the market. Pre-clinical studies in animal subjects or test tubes aim establish the drug’s general safety. Phase 0 trials, a new addition to the regulatory process, involve very low, single doses of the drug given to human subjects to test its effects against what was seen in pre-clinical studies. In Phase I trials, small groups of humans are given escalating doses of the drug to find the proper therapeutic dose and again to check the safety of the product. Phase II involves a larger group of human subjects and is intended to confirm the safety and efficacy of the drug at a pre-determined dosage. Phase III studies are much more extensive, involving randomized, double-blind trials with large human groups; the end-goal of Phase III trials is a regulatory submission. Once the drug is approved, Phase IV trials continue to monitor drug’s effects once it is being marketed and sold. </p> <div style="text-align: justify;"> </div> <p style="text-align: justify;" class="MsoNormal"><!--[if !supportEmptyParas]--><!--[endif]--> This exhaustive process often takes eight to ten years from beginning to end and costs, based on multiple estimates, between $800 million and $1.7 billion per drug. Many new drugs get rejected along the way when efficacy expectations are not met or unforeseen side effects arise in trials. Because of the costs and risks associated with this process, the likelihood of a drug getting to market, and the potential profits if it does, are the guiding factors that determine what drugs a company will invest in. A drug’s net present value, or NPV, is risk-adjusted to calculate the attractiveness of a drug in development. And for new antibiotics, the costs and benefits often don’t add up.</p><p style="text-align: justify;" class="MsoNormal"><!--[if !supportEmptyParas]--><!--[endif]--><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_PpFqzlu2XFY/S56cROhxusI/AAAAAAAAAEc/u8AqvZ6SSpY/s1600-h/silly+computer.png"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 313px; height: 235px;" src="http://2.bp.blogspot.com/_PpFqzlu2XFY/S56cROhxusI/AAAAAAAAAEc/u8AqvZ6SSpY/s320/silly+computer.png" alt="" id="BLOGGER_PHOTO_ID_5448964418936355522" border="0" /></a>Antibiotics cost as much and take as long as other drug classes to develop and test but often bring in less revenue for the companies that produce them. While a patient requiring antibiotic treatment will often only need medication for 1-2 weeks, those on heart, cholesterol, or blood pressure medications will take these drugs for years, if not decades, of their lives. In addition, the burden of antibiotic resistance means that new drugs will inherently become less useful – and therefore less marketable – over time, and that doctors will be pressured <i>not</i> to prescribe the drug unless it is absolutely necessary. And while a <a href="http://www.tufts.edu/med/apua/Miscellaneous/Glossary.html#narr">broad-spectrum</a> antibiotic that can be used for a range of infections is more profitable for the pharmaceutical company, resistance trends mean that narrow-spectrum drugs are preferred in the clinical community.<br /></p> <div style="text-align: justify;"> </div> <p style="text-align: justify;" class="MsoNormal"><!--[if !supportEmptyParas]--><!--[endif]--> Most of the antibiotics in the development pipeline are part of the same drug classes as those that are marketed now – meaning resistance is likely to develop sooner, because the drugs work by similar mechanisms. The <a href="http://www.idsociety.org/">Infectious Diseases Society of America</a> <a href="http://www.idsociety.org/Content.aspx?id=5652">reports</a> that since 1998, ten new antibiotics have been approved by the <a href="http://www.fda.gov/">FDA</a>, and only two of those work on novel targets and are thus not at risk for cross-resistance. The lack of new antibiotics is <a href="http://www.nytimes.com/2010/02/27/business/27germside.html">especially a problem for gram-negative bacterial infections</a>, which are more difficult to target than gram-positive bacteria. </p> <div style="text-align: justify;"> </div> <p style="text-align: justify;" class="MsoNormal">Some professionals in the field believe that market conditions are creating renewed interest in antibiotic development, but others argue that regulatory action must be taken to make these classes of drugs more appealing (more profitable) for pharmaceutical companies. For example, the government could approve patent extensions for antibiotics, meaning that pharmaceutical companies could be the sole marketer of these drugs for longer before generics were made available, increasing the window of maximum revenue. Currently, U.S. drug patents have a 20-year duration that begins before the start of clinical trials. But even if regulatory measures are taken, the danger of coming up empty handed for treatment of resistant infections remains. Finding new modes of action and targets for antibiotics remains a challenge, and any new drug still faces a decade-long process of testing and development before it may be approved. </p> <p class="MsoNormal"><!--[if !supportEmptyParas]--> <!--[endif]--><o:p></o:p></p>Genevra Pittmanhttp://www.blogger.com/profile/09186313642544757475noreply@blogger.com0